Ahead on health insurance

It was mishandling the very personalized economics of home buying that gave rise to a staggering international monetary crisis. It is, however, not a mortgage but a pile of medical bills that is the single leading cause of personal bankruptcy in this country. The economic downturn, with its layoffs and credit squeeze, is sure to increase the number of families confronting that threat.

Even in the face of all that is wrong with the economy, even as government at all levels is forced to reorder spending priorities, increasing the number of families with health insurance is essential. New Jersey has started work on a good idea to expand health coverage by getting maximum use out of federal health dollars and rerouting what the state already spends. The hard times are reason to keep going, not rein in the effort.

Both presidential candidates have promised health insurance action on the national level. Given the way Washington works, it is not likely that any president or Congress will come to agreement on that task soon. In the meantime, the problem is only getting worse.

A report released last week by the Economic Policy Institute in Washington said 75.6 percent of New Jerseyans had health coverage through an employer during 2000-01. That figure dropped to 69.7 percent in 2006-07, the 14th-greatest decline in the country. Unemployment and the struggle by business against the high cost of health insurance are eroding what has been the foundation of U.S. health coverage.

New Jersey, however, is uniquely positioned to make major inroads into the problem. In a Star-Ledger interview about the presidential candidates' health plans, David Knowlton, director of the New Jersey Health Care Quality Institute, a nonprofit think tank, said:

"We've designed a better plan to cover the uninsured in New Jersey than either candidate has created."

New Jersey is building around FamilyCare, which uses money from the federal State Children's Health Insurance Program to buy health insurance policies for low-income children and some adults. Families above the poverty scale buy coverage for their children by kicking in a share of the premiums based on their income.

Sen. Joseph Vitale (D-Middlesex), the prime author of New Jersey's universal coverage plan, said the next step will be to carefully set premium rates that will allow any family that needs insurance to purchase FamilyCare coverage for adults and kids. The state will also take care to make sure those with very low income are enrolled in the Medicaid program, which will earn the state one federal dollar for every state dollar spent.

The great advantage New Jersey has is that it already spends a considerable sum subsidizing the care that hospitals provide to patients who cannot pay their own way. If the state can reroute the millions spent on that charity care to buy comprehensive insurance -- which covers routine doctor visits, preventive care and chronic disease management, not just hospital crisis care -- New Jersey should be able to buy better care for more people.

It will not be an easy task under the pressure of an economic downturn, but the hard times are reason for New Jersey to keep working on its own unique answer to the health insurance crisis.